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N Co" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the I ws and 3 <br /> regulations of the State of Wisconsin. "' o <br /> m m <br /> c <br /> m <br /> OWNER TELEPHONE `I n 0 <br /> ADDRESS % 00 <br /> EMERGENCY//FIRE NUMBER /U�2Z ROAD NAME Z S44a2bujP& t o� <br /> G <br /> LEGAL DESCRIPTION (see tax receipt) -7JO��R 235 I28 N22 <br /> 2lo S25 1 i?18w AcesS <br /> CONTRACTOR J,K PI: LO 3K182.Soo5400 PCJ— C�,/ "t g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION 0 <br /> 0 <br /> N r <br /> STRUCTURE/ADDITION USE: o a <br /> (Home/Cabin;Commercial Business; Bedroom;/beck;etc.) If Z <br /> O Do <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DIF). o <br /> 3. Show dimensions in feet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c) building <br /> measurement to the ordinary high water mark of lake, stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE 0 ISSUED 0 c m <br /> PLOT PLAN z <br /> _A _A <br /> C � <br /> 1 1 <br /> q0, <br /> 1 m s <br /> t ! Dom" I <br /> 4 111, 40 <br /> .r NFA <br /> 1 <br /> L' <br /> V 1 t <br /> 0 `1 <br /> F AW <br /> Z a`)' <br /> 113-Al <br /> M I i z <br /> � �drianc�# �35 <br /> i <br /> C SAµ Y� Fos- (ocojr.. ail' Soff'iL >0u 0- I <br /> Pel bawpJ. %tLd, <br /> sos4-llad ra r997 "/3t)o <br /> I 1 <br /> Lo+ I { D �N�Nr DDOm <br /> MC v/ M cam.> > o aE m <br /> CONDITIONS OF PERMIT: J o m N; C M <br /> 42 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z fo : —,;2 �: -{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o 21 y b° j =1 <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 2 m <br /> n {» <br /> o ; <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. u W sb <br /> . p <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap �r <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N v <br /> access to the described premises any reasonable time for the purpose of inspection. : 0 0 :d <br /> m 3 <br /> 4 -QIf/J m m :o <br /> SIGN HERE it .Y-. �__._rY - y <br /> (signature of owner or bultrig contractor) --(Hate), <br /> ZONING ADMINISTRATOR <br /> e <br /> ` 5 94 � X x <br /> � +n M "i°'�n oxo»x—n <br /> TOWNSHIP PERMITS MAY BE REQUIREDrn <br /> 000woc (/1 <br /> X <br /> 0 <br />